Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2015; 21(3): 969-976
Published online Jan 21, 2015. doi: 10.3748/wjg.v21.i3.969
Accuracy of routine multidetector computed tomography to identify arterial variants in patients scheduled for pancreaticoduodenectomy
Feng Yang, Yang Di, Ji Li, Xiao-Yi Wang, Lie Yao, Si-Jie Hao, Yong-Jian Jiang, Chen Jin, De-Liang Fu
Feng Yang, Yang Di, Ji Li, Xiao-Yi Wang, Lie Yao, Si-Jie Hao, Yong-Jian Jiang, Chen Jin, De-Liang Fu, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
Author contributions: Yang F and Fu DL designed the study; Yang F, Di Y, Li J, Wang XY, Yao L, Hao SJ and Jiang YJ collected data for this research; Yang F, Jin C and Fu DL analyzed the data; Yang F wrote the manuscript; and Jin C and Fu DL edited the manuscript.
Supported by New Outstanding Youth Program of Shanghai Municipal Health Bureau, No. XYQ2013090; Shanghai Young Physician Training Program and the Zhuo-Xue Project of Fudan University; and The key Project of Oncological Subject of the Ministry of Health of China 2012.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: De-Liang Fu, Professor, Department of Pancreatic Surgery, Pancreatic Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Central Urumqi Road, Shanghai 200040, China. surgeonfu@163.com
Telephone: +86-21-52887164 Fax: +86-21-52888277
Received: June 4, 2014
Peer-review started: June 5, 2014
First decision: July 9, 2014
Revised: July 30, 2014
Accepted: September 18, 2014
Article in press: September 19, 2014
Published online: January 21, 2015
Processing time: 229 Days and 22.7 Hours
Abstract

AIM: To assess the efficacy of cross-sectional multidetector computed tomography (MDCT) imaging without arterial reconstruction to identify aberrant right hepatic artery (RHA) and celiac artery stenosis (CAS) in patients scheduled for pancreaticoduodenectomy.

METHODS: Patients with peri-ampullary and pancreatic head tumors who underwent routine preoperative MDCT and subsequent computed tomography (CT) angiography (CTA), conventional angiography or pancreaticoduodenectomy between September 2007 and August 2013 were identified. Retrospective analysis of imaging data was undertaken using CTA, conventional angiographic and surgical findings as the reference standards. The accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MDCT in evaluation of aberrant RHA and CAS were calculated.

RESULTS: A group of 458 patients met the inclusion criteria of this study to detect aberrant RHA, and 181 cases were included to identify CAS. Fifty-four (11.8%) patients were confirmed to have aberrant RHA, while 12 (6.6%) patients with CAS were demonstrated. MDCT yielded an accuracy of 98.5%, sensitivity of 96.3% and specificity of 98.8% in the detection of aberrant RHA. The sensitivity, specificity, PPV and NPV of MDCT for detecting CAS were 58.3%, 98.2%, 70% and 97.1%, respectively.

CONCLUSION: Routine MDCT is recommended such that surgeons and radiologists be alerted to the importance of arterial variants on preoperative CT scans in patients scheduled for pancreaticoduodenectomy.

Keywords: Pancreaticoduodenectomy; Aberrant hepatic artery; Celiac artery stenosis; Multidetector computed tomography; Angiography

Core tip: Few studies have investigated the ability of routine multidetector computed tomography (CT) scans without arterial reconstruction, which are commonplace in medical practice, to assess peri-pancreatic arterial variants such as aberrant right hepatic artery and celiac artery stenosis prior to pancreaticoduodenectomy. This study demonstrated that a routine multidetector CT scan is useful to evaluate aberrant right hepatic artery in the preoperative planning of pancreatic surgery, although it is limited by lower sensitivity for evaluating celiac artery stenosis. It is recommended that surgeons and radiologists be alerted to the importance of arterial variants on preoperative CT scans in patients scheduled for pancreaticoduodenectomy.